Provider Demographics
NPI:1669477907
Name:GRAND HAVEN HOMES, INC.
Entity Type:Organization
Organization Name:GRAND HAVEN HOMES, INC.
Other - Org Name:LINN MANOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-377-4611
Mailing Address - Street 1:1140 ELIM DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-5817
Mailing Address - Country:US
Mailing Address - Phone:319-377-4611
Mailing Address - Fax:319-377-4612
Practice Address - Street 1:1140 ELIM DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-5817
Practice Address - Country:US
Practice Address - Phone:319-377-4611
Practice Address - Fax:319-377-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN-847314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805549Medicaid
IA0805549Medicaid